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News Bulletin : ADA News Bulletin December 2011
38 DECEMBER 2011 clinical hints TEASER There are two. The first was provided by Harry Rich (Double Bay 2028). He provided a complete description of how it is used. Can you? The second was purchased by your Notary in 1950 and used sporadically for several decades. Again, the question is: how is it used? Post, telephone or e-mail your answers as indicated below. Correct answers accompanied by clinical hints get an extra slip in the hat, thus improving your chances of being drawn, and thereby winning the handsome, inscribed, antique metal ADA paperweight. There have been very few Clinical Hints or TEASERS submitted recently, and none at all by recent graduates or female dentists. We all know you are out there, so how about sharing your creativity with the oldies. Send your offerings to Barrie Gillings, Phone: 02 9144 3787; Fax: 02 9440 9159; e-mail: firstname.lastname@example.org Very observant readers will note there are no virgin hinters. They are all the usual suspects. How about joining this exclusive group? The hinters were: ANZAE (per E Rebellato), G Freeman, M Knapp, M Maltby, M Reznik and S Zahedi. instruct the patient to place the carbamide peroxide over the discoloured tooth when wearing the tray for, say, 10 nights. The drainage holes will greatly reduce the bleaching effect on the adjacent teeth. If a tooth has inadequate supragingival tooth structure or inadequate ferrule, then an indirect restoration such as a crown may not be feasible. But before you condemn the tooth to extraction, ask the patient whether they would like you to attempt to save the tooth, and discuss the various options. An alternative, such as an amalgam crown or even a full stainless steel shell crown may be an acceptable option. Very occasionally, you may be confronted with an edentulous patient whose ridges are much larger than any tray you have in your collection, or indeed have even seen. They are usually Pacific Islanders or Africans. You may be able to re-shape the largest disposable plastic trays you have using heat, and then obtain a reasonable initial impression, from which you can prepare a usable cast on which to make acceptable individual trays. Alternatively, if the patient already has dentures, use these as preliminary impression trays. If you are adjusting an occlusion by grinding the cusps of natural teeth, use a high speed bur with the water spray shut off. But you must use very light sweeps of the bur, stone or diamond to avoid overheating. Done carefully, the slight overheating will stimulate the underlaying dentine, so tell the patient to indicate when they feel the heat. This way, you can stop removing enamel before you expose the underlying dentine, and complete the adjusting by working on the opposing tooth. Removal of dried alginate from metal trays can be time-consuming. Try soaking them in hot water to which you have added Finish dishwashing powder or liquid. The tablets are convenient but more expensive. You may be surprised at how rapidly it works. Cobalt-chromium partial dentures occasionally suffer from broken clasps. Clever dentists can usually prepare replacement wrought wire clasps, but achieving an accurate clasp fit on a new cast from a new alginate impression can be difficult, as the chrome denture is unlikely to fit this cast accurately. If the original cast that came with the new denture is relatively undamaged, give it to the patient after denture issue, and tell them to keep it in case of clasp breakage. Alternatively, take the alginate impression with the denture in place in the mouth, then place the denture in the impression and pour the cast. The roots of crowned teeth often have an axis direction which is different from what you might anticipate, and their pulp chambers are often partly calcified. Placing rubber dam before you prepare an access cavity will hinder your visualisation of root direction and pulp chamber of the crowned tooth. Furthermore, being able to view the adjacent tooth crowns can provide additional guidance.
ADA News Bulletin November 2011
ADA News Bulletin February 2012